Summaries of health policy coverage from major news organizations

CALIFORNIA: HMOs AGGRESSIVELY COURTING MEDI-CAL PATIENTS

As California prepares for the mandatory HMO enrollment of more than three million Medi-Cal recipients this fall, health plans have "touched off a pitched marketing battle" to entice patients to sign up, LOS ANGELES TIMES reports. Sales agents for HMOs "are turning up at schoolyards, doctors' offices, churches, clinics and hospitals" in an attempt "to exploit what is arguably the most sweeping change ever in medical care for California's poor." The TIMES notes that mandatory Medi-Cal HMO enrollment "could be a goldmine" for health insurers: In Los Angeles County alone, Medi-Cal spending is expected to total $9.5 billion over the next six years. However, health care advocates and HMOs are concerned that the state "may be woefully unprepared -- or even unwilling -- to monitor the sometimes questionable or illegal recruiting schemes" used by health plans. There is also concern that the state Department of Health Services, which is responsible for privatizing Medi-Cal, "is also charged with policing" the plans. BAD PRACTICE: The TIMES notes that Medi-Cal reform legislation signed by Gov. Pete Wilson (R) last year took effect July 1 and prohibits door-to-door marketing and telephone solicitations and bans HMOs from directly enrolling patients. Instead, patients will be enrolled by independent contractors. However, the TIMES reports that "marketing agents for HMOs have tracked down Medi-Cal recipients at their homes, aboard city buses, and at check-cashing outlets and welfare offices." The TIMES reports that marketing agents have offered illegal $20 inducements to potential enrollees. In addition, according to the TIMES, recruiters have "lied" to Medi-Cal recipients, telling them that they would lose their benefits if they didn't join an HMO or that the plan would let them see any physician they choose. MORE: In addition to direct contact with Medi-Cal beneficiaries, some HMOs have reportedly offered kickbacks to doctors and hospitals for referring their patients to a particular health plan. And HMO marketers have "literally set up shop in doctors' offices and hospitals around L.A. County." Critics of HMOs say that this practice is "in effect using the providers' reputations and influence to help steer Medi-Cal recipients to specific HMOs." However, state officials say that HMOs should be allowed to market at doctors' offices and hospitals, "saying those are the logical places to reach patients." CONCERN: Critics have also expressed concern over the state awarding contracts to health plans "with questionable track records." "Especially troubling to many health care experts" is the state's decision to award a $5.9 billion Medi-Cal contract to Foundation Health -- one of the largest HMOs in the state -- and two subcontractors. The TIMES reports that Foundation has a "record of marketing abuses" and that a 1994 audit by the state cites violations of state licensing requirements in eight categories, including "quality of care, continuity of care, handling of patient grievances and preventive services." State health officials "acknowledge" that the bidding process "did not take into account the state's own medical quality reviews," and said that the companies were measured by how well they met "state and federal bidding criteria" (Olmos, 7/22).

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